下部尿路の尿流動態研究 : I. 膀胱ペースメーカーの臨床応用

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A42-year-old man Hell down from the roof of house on Oct. 11, 1973 and got a complete spinal cord injury at C-6. He underwent the implantation of bladder pacemaker, which we developed and tested in a series of canine experiments. External transmitter contains rechargeable nickel-cadmium batterics, and transmits power through skin at 200 KHz to the receiver. The maximum power of 18 volts in Type-I and 29 volts in Type-II can be generated when the transmitter-receiver distance is 0. Electric current of 33 Hz, 4 msec duration of biphasic square wave is produced by the electric circuit inside the receiver. Six disk-type electroldes are connected with the receive. The electrodes and leads are made of stainless steel. The electrodes were fixed on the bladder serosa in two circles between the ureterovesical junction and bladder apex. Following sphincterotomy and subarachnoid phenolization, which lowered the urethral resistance from 105 to 26 mmHg, a bladder stimulator Type-I was implanted on May 29, 1975. Sixty-nine mmHg of isometric intravesical pressure was obtained on the operation table. Three weeks later the isometric pressure fell down to 39 mmHg in response to stimulation. An interrupted and weak urinary stream was observed after the end of electrostimulation. Insufficient power of pacemaker and elevation of tissue impedance were thought to be the cause of failure. The receiver was removed to be replaced with a more powerful one on July 3,1975. The pacemaker Type-II was re-implanted and connected with the previously fixed electrodes on Oct. 31, 1975, yielding 70 mmHg of isometric bladder pressure. A powerful micturition was accomplished without spasm of lower extremities by applying the stimulation of 20 to 30 sec duration at 30 sec intervals. Two hundred to 300 ml of urine was evacuated by the repetition of this on-and-off maneuver without residual urine for the first 6 weeks. Later the residue gradually increased in volume in accord with the change of voiding mode; micturition took place after the cessation of stimulation. Electrostimulation elevated the bladder pressure without urinary stream because of concomitant spasm of the external sphincter and pelvic floor muscles. The detrusor-sphincter dyssynergia is apparently responsible for this change in voiding mode. Several episodes of pyelonephritis, fistular formation and residue of up to 130 ml forced us to remove the whole receiver-electrode unit on Apr. 17, 1976.
社団法人日本泌尿器科学会の論文

下部尿路の尿流動態研究 : I. 膀胱ペースメーカーの臨床応用

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